{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T18:21:47Z","timestamp":1777486907698,"version":"3.51.4"},"reference-count":29,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"unspecified","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,27]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Trauma remains a significant contributor to global morbidity and mortality, with low- and middle-income countries being particularly affected due to limited resources and delayed medical care. Although trauma scoring systems such as MGAP (Mechanism, Glasgow Coma Scale, Age, Arterial Pressure) and GAP (Glasgow Coma Scale, Age, Systolic Blood Pressure) can be used for rapid risk assessment, they have never been validated for use in conflict-affected regions like Iraq. This study assesses the prognostic accuracy of MGAP and GAP in predicting in-hospital mortality, intensive care unit admission and surgical intervention in multiple trauma cases from Iraq.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>A prospective observational cohort study is set to take place at Al-Kadhimiya Teaching Hospital in Baghdad, running from April 2025 to March 2027. This study will include patients aged 16 and older who experience multiple trauma within 6\u2009hours of the event. Estimated sample size of 522 participants. Demographic information, mechanism of injury, vital signs and clinical outcomes as a result of accidents will be collected. The MGAP and GAP scoring systems will be used and their results will subsequently be compared using receiver operating characteristic curve analysis. This will involve assessing the area under the curve to evaluate the predictive performance of the scores. The significant threshold will be set at p&lt;0.05.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study was approved by the Research Ethics Committee of the College of Medicine, Al-Nahrain University (Approval No. UNCOMIRB20250383), with approval valid from 7 March 2025 to 7 March 2027. Written and verbal informed consent was obtained from all participants prior to enrolment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial post-results\" xlink:href=\"NCT06732791\">NCT06732791<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-105628","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T14:30:26Z","timestamp":1777386626000},"page":"e105628","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["A comparative evaluation of the prognostic performance of MGAP and GAP trauma scores in predicting clinical outcomes in multiple trauma patients: protocol for a prospective cohort study from Baghdad, Iraq"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct06732791","registry":"10.18810\/clinical-trials-gov","type":"postResults"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1657-6917","authenticated-orcid":false,"given":"Abdulillah R","family":"Khamees","sequence":"first","affiliation":[{"name":"Al-Nahrain University College of Medicine, Baghdad, Baghdad, Iraq"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdelfattah A","family":"Gomaa","sequence":"additional","affiliation":[{"name":"Al-Azhar University Faculty of Medicine, Nasr City, Cairo Governorate, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdulhadi M A","family":"Mahgoub","sequence":"additional","affiliation":[{"name":"University of Gezira Faculty of Medicine, Wad Madani, Al Jazirah, Sudan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saja J","family":"Abotaleb","sequence":"additional","affiliation":[{"name":"Al-Nahrain University College of Medicine, Baghdad, Baghdad, Iraq"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdeljalil El","family":"Hilali","sequence":"additional","affiliation":[{"name":"Ibn Zohr University, Agadir, Souss-Massa-Draa, Morocco"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salim K","family":"Hajwal","sequence":"additional","affiliation":[{"name":"Al-Mustaqbal University, Hillah, Iraq"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hasan Naeem","family":"Kareem","sequence":"additional","affiliation":[{"name":"University of Al-Qadisiyah, Diwaniyah, Al-Q\u0101disiyyah Governorate, Iraq"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed A","family":"Hamdawi","sequence":"additional","affiliation":[{"name":"Al-Nahrain University College of Medicine, Baghdad, Baghdad, Iraq"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"2026042807300618000_16.4.e105628.1","unstructured":"World health organization . 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Addressing the increasing burden of trauma in humanitarian settings. 2024. Available: https:\/\/www.emro.who.int\/media\/news\/addressing-the-increasing-burden-of-trauma-in-humanitarian-settings.html [Accessed 17 May 2025]."},{"key":"2026042807300618000_16.4.e105628.14","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1001\/jamasurg.2019.3475","article-title":"Association of Prehospital Time to In-Hospital Trauma Mortality in a Physician-Staffed Emergency Medicine System","volume":"154","author":"Gauss","year":"2019","journal-title":"JAMA Surg"},{"key":"2026042807300618000_16.4.e105628.15","first-page":"317","article-title":"Trauma severity scores","volume":"44","author":"Restrepo-\u00c1lvarez","year":"2016","journal-title":"Colombian Journal of Anesthesiology"},{"key":"2026042807300618000_16.4.e105628.16","doi-asserted-by":"crossref","DOI":"10.3390\/diagnostics11112156","article-title":"Applicability of anatomic and physiologic scoring systems for the prediction of outcome in polytraumatized patients with blunt aortic injuries","volume":"11","author":"Omar","year":"2021","journal-title":"Diagnostics (Basel)"},{"key":"2026042807300618000_16.4.e105628.17","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181cc4a67"},{"key":"2026042807300618000_16.4.e105628.18","doi-asserted-by":"crossref","DOI":"10.1186\/s12873-022-00653-1","article-title":"Evaluation of the revised trauma score, MGAP, and GAP scoring systems in predicting mortality of adult trauma patients in a low-resource setting","volume":"22","author":"Mohammed","year":"2022","journal-title":"BMC Emerg Med"},{"key":"2026042807300618000_16.4.e105628.19","article-title":"A retrospective study on evaluating GAP, MGAP, RTS and ISS trauma scoring system for the prediction of mortality among multiple trauma patients","volume":"76","author":"Farzan","year":"2022","journal-title":"Ann Med Surg (Lond)"},{"key":"2026042807300618000_16.4.e105628.20","unstructured":"Mahnaz Y , Zahra G , Kazem J , et al . The accuracy of GAP and MGAP scoring systems in predicting mortality in trauma; a diagnostic accuracy study. 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